Haemosuccus pancreaticus due to true splenic artery aneurysm: a rare cause of massive upper gastrointestinal bleeding

Sadhu, Sagar; Sarkar, Sukanto; Verma, Rakesh; Dubey, SK; Mk, Roy

doi:10.1093/jscr/2010.5.4

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…Overall, 120 males, 95 females, and 135 patients whose gender was not reported received open surgical repair (OSR) or endovascular treatment (EVT) for an r-SAA (258) or a r-SAPA (92) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 …”

Section: Resultsmentioning

confidence: 99%

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Rinaldi,

Brioschi,

Marone

2023

JCM

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Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. Materials and Methods: A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. Results: We selected 129 studies reporting on 350 patients—185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)—24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair —6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. Conclusions: Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.

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Section: Resultsmentioning

confidence: 99%

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Rinaldi,

Brioschi,

Marone

2023

JCM

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“…[ 1 2 3 ] Rarely, pseudoaneurysm of other peripancreatic vessels such as hepatic artery, celiac artery, and gastroduodenal artery erodes into the pancreatic duct causing hemosuccus pancreaticus. [ 1 3 4 ] The condition is primarily seen in elderly male, usually associated with pancreatitis. This rare condition in our patient was accompanied by portal hypertension yet another common cause of GI bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 2 ] It occurs after the opening of pseudoaneurysm or aneurysm of splenic or gastroduodenal artery into the pancreatic duct, thus allowing blood to enter into the duct and empty from the papilla into the duodenum. [ 3 4 ] Other causes of GI bleeding such as portal hypertension and infection with hookworm are well known.…”

Section: Introductionmentioning

confidence: 99%

Association of three H - Hookworm, hemosuccus pancreaticus, and hypertension (portal) in a patient with melena

Kale

Sahu

Verma

et al. 2017

J Global Infect Dis

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Hookworm infestations, endemic in India, are a common cause of iron deficiency anemia. Hemosuccus pancreaticus, a rare clinical condition, is due to passage of blood into the pancreatic duct possibly through a route between an aneurysm of an artery close to the pancreas and/or pancreatic duct, leading to gastrointestinal (GI) bleeding. Portal hypertensive upper GI bleed is also known since long. We report a case of a 38-year-old male with a history of alcoholism who was being investigated for GI bleeding who had concomitant hookworm infestation, hemosuccus pancreaticus as well as portal hypertension. To the best of our knowledge, this is the first report of common occurrence of hemosuccus pancreaticus and portal hypertension with hookworm infection. This case signifies the importance of infectious causes of GI bleeding to be considered even in cases where anatomic malformations or pathophysiological alterations are predominant.

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Tortuous Cervical and Intracranial Arteries and Basilar-Carotid Dolichoectasia

McKinney

2017

Atlas of Normal Imaging Variations of the Brain, Skull, and Craniocervical Vasculature

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Haemosuccus pancreaticus due to true splenic artery aneurysm: a rare cause of massive upper gastrointestinal bleeding

Cited by 8 publications

References 5 publications

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Association of three H - Hookworm, hemosuccus pancreaticus, and hypertension (portal) in a patient with melena

Tortuous Cervical and Intracranial Arteries and Basilar-Carotid Dolichoectasia

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